Medicare Compliance & Reimbursement

Medical necessity and time spent will dictate payment.

If a patient is brought in to the emergency department with more than one medical condition, two or more physicians might need to attend. However, you'll need to keep an eye out for circumstances that might land you in claim scrubber land.

When one provider performs cognitive E/M services and another performs a procedure, payment issues are relatively rare. On the other hand, when two physicians provide E/M services during the same ED visit, watch out for claim scrubber errors and payer denials, says
Betty Ann Price, BSN, RN President and CEO of PRCS, Inc. in Palmetto, Florida. Historically, one provider would utilize ED E/M codes (99281-99285) and others would report a consultation code (99241-99245). Reimbursement may be dependent upon a combination of factors under the umbrella of medical necessity.
 
Medicare describes concurrent care [...]